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Endocr Pract. 2019 Nov 4. doi: 10.4158/EP-2019-0392. [Epub ahead of print]

MANAGEMENT OF HYPERPARATHYROIDISM IN KIDNEY TRANSPLANTATION CANDIDATES: A NEED FOR CONSENSUS.

Author information

1
From: Memorial Healthcare System, Hollywood, FL USA.
2
Loyola University Medical Center, Maywood, IL USA.
3
New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY USA.
4
Massachusetts General Hospital, Boston, MA USA.

Abstract

Objective: To assess the evolving standards of care for hyperparathyroidism in kidney transplant candidates. Method: An eleven question, IRB-approved survey was designed and reviewed by multiple institutions. The questionnaire was made available to the American Society of Transplantation's Kidney Pancreas Community of Practice membership via their online hub from April through July 2019. Results: Twenty percent (n=41) of kidney transplant centers responded out of 202 programs in the United States. Forty-one percent (n=17) of respondents believed medical literature supports the concept that a serum PTH greater than 800 pg/ml could endanger the survival of a transplanted kidney and therefore makes transplantation in an affected patient relatively or absolutely contraindicated. Sixty-six percent (n=27) said they occasionally recommend parathyroidectomy for secondary hyperparathyroidism prior to transplantation and 66% (n=27) recommend parathyroidectomy after transplantation based on persistent, unsatisfactory post-transplantation parathyroid hormone levels. Forty-six percent (n=19) prefer sub-total parathyroidectomy as their choice; 44% (n=18) had no standard preference. Endocrine surgery and otolaryngology were the most common surgical specialties consulted to perform parathyroidectomy in kidney transplant candidates. The majority of respondents (71%, n=29) do not involve endocrinologists in the management of kidney transplantation candidates. Conclusion: Our survey shows wide divergence of clinical practice in the area of surgical management of kidney transplantation candidates with hyperparathyroidism. We suggest that medical/surgical societies involved in the transplantation care spectrum convene a multi-disciplinary group of experts to create a new section in the kidney transplantation guidelines addressing the collaborative management of parathyroid disease in transplantation candidates.

KEYWORDS:

Chronic Kidney Disease-Mineral and Bone Disorder; Secondary hyperparathyroidism; diagnostic imaging; surgery

PMID:
31682519
DOI:
10.4158/EP-2019-0392

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